Asylums began acquiring medical staff. “Madness,” as a term, fell out of favor, and was seen as a slur on the sick. This was a clear turning point in the way insanity was understood in the West: Madness started to be understood as an affliction of body, not the spirit.
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The transition over time from “madness” to “mental illness” is a linguistic tweak that accounts for a larger metaphysical reshuffling. This is a recurring theme in Scull’s work, which largely focuses on the West: Insanity, he argues, is culturally dependent, as is the language used to describe it. He does make some references to how madness was treated in non-Western cultures, and these reinforce his broader point: The words people use to describe mental illness say a lot about how they understand the nature of existence.
In early Islam, for example, prophetic healings for insanity included prayers, bloodletting, and “cauterization of the head with hot irons.” This last technique was used, Scull writes, because demons and spirits were believed to be afraid of iron. Not coincidentally, the Arabic word for “genie” or “spirit” is jinn—the word from which majnoon, or “crazy,” is derived.
Until very recently in China, “madness was never interpreted as a distinct illness, but was instead, like other forms of ill-health, seen as deriving from a more comprehensive corporeal and cosmological imbalance,” Scull writes. The words mostly commonly used to describe possession and mental confusion, kuang, feng, and dian, were common-sense descriptions of symptoms (such as loss of verbal or emotional control), rather than an ongoing state of being mad or insane.
In the decades following World War II, the focus of psychiatry shifted away from the psychoanalytic techniques advocated by Freud and his followers and toward biological factors and causes. As Steven Sharfstein, the former president of the American Psychiatric Association, put it, public discourse around mental illness transformed from “the biopsychosocial model” to “the bio-bio-bio model.” This shift matters for the relationship between religion and madness. Even those who remain deeply religious in the U.S. or other developed countries likely accept some version of the biological view of mental illness. Some religious leaders have been vocal in their acceptance of this; in a 1996 speech, for example, Pope John Paul II called mental illness “the most absurd and incomprehensible [affliction].”
Yet for some, religion still plays an important role in treatment: A 2003 study published by Health Services Research found that more people reach out to members of the clergy about mental-health issues than to psychiatrists or doctors. And some traditions also remain actively open to evidence of divine influence in everyday life. In 2012, for example, roughly a quarter of American religious congregations reported instances of members speaking in tongues, a five-percentage-point bump from what was reported in 1998. But even prominent religious institutions have faced awkwardness in their teachings about possessions and visions. Pope Francis often speaks about the influence of Satan, and last summer, he officially recognized the International Association of Exorcists, a small group of roughly 250 priests who still follow the practice of casting out demons. On the other hand, the Vatican’s process for legitimizing miracles and canonizing saints is as close to technocratic and rational as it can get while still involving supernatural encounters: Medical miracles, for example, often go through years-long investigations by multiple panels of local clergymen, doctors, theologians, and Vatican advisors.